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Spa Therapy and Balneotherapy in Fibromyalgia

Spa Therapy and Balneotherapy in Fibromyalgia. Arif Dönmez. FIBROMYALGIA. Fibromyalgia syndrome is a chronic disorder characterized by widespread musculoskeletal pain and tenderness in previously defined tender point sites. MAIN FEATURES g eneralized pain fatigue sleep disturbances.

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Spa Therapy and Balneotherapy in Fibromyalgia

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  1. Spa Therapy and Balneotherapy inFibromyalgia Arif Dönmez

  2. FIBROMYALGIA Fibromyalgia syndrome is a chronic disorder characterized by widespread musculoskeletal pain and tenderness in previously defined tender point sites. MAIN FEATURES • generalized pain • fatigue • sleep disturbances

  3. DIAGNOSIS • Widespread pain in combination with • tenderness at 11 or more of the 18 specific tender point sites (Wolfe F, et al. The American Collegeof Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.Arthritis   Rheum1990;33(2):160-172.)

  4. COMMON CO-MORBID CLINICAL CONDITIONS • Chronic fatigue syndrome • Irritable bowel syndrome • Depression and anxiety disorders • Tension and migraine headache • Temporomandibular disorder • Interstitial cystitis

  5. NON-PHARMACOLOGICAL INTERVENTION • Exercise • Patient education • Cognitive behavioral therapy • Multidisciplinary therapy • Balneotherapy • Relaxation training • Biofeedback • Acupuncture, • Electrotherapy • Massage therapy • ........................

  6. Outcome measures for FM* • Pain • Tender points • Physical function • Cardio respiratory fitness • Self reported physical function • Musculoskeletal performance • Global well being or perceived improvement • Self-efficacy • Fatigue and sleep • Psychological function (Busch A, Schachter CL, Peloso PM, Bombardier C. Exercise for treating fibromyalgia syndrome. (Cochrane Review). In:The Cochrane Library, Issue 3, 2003. Oxford

  7. BALNEOTHERAPY STUDIES WİTH FM • One bath effects • Observational studies • Studies with control groups • Studies in outpatient settings • Studies in spa centers • Balneotherapy group in a spa center / Controls in daily living area

  8. ONE SULPHUR BATH Gutenbrunnner Chr, Englert G, Neues-Lahusen M, Gehrke A: Analgetische Wirkungen von Natürlichen Schwefelbaedern und Kaeltekammerexpositionen bei Fibromyalgie. Phy Rehab Kur Med 9 (1999) 56-62

  9. OBSERVATIONAL STUDY 28 patientswith PsA+FM • Every other day sulphur bath ( 37oC, 20 min ) • Every other day peloid packing on 4 extremity and back (40-42oC, 20 min) • Heliotherapy from 2 X (10 min) up to – 6 hours • Bath on Dead Sea BeforeAfter • Tender points 12,9 7,4 p<0.001 • Morning stiffness 33,2 min 12,8 min p<0.002 • inflamed joints 18,4 9.0 p<0.001 Sukenik S et al:Balneotherapy at the Dead Sea for patients with psoriatic arthritis and concomitant fibromyalgia. IMAJ 2001;3:147-50

  10. STUDIES WITH CONTROL GROUPS • Studies in outpatient settings • Balneotherapy (Evcik D, Altan L) • Balneotherapy + exercise / exercise(Yurtkuran M) • Studies in spa centers • Both Balneotherapy and Control groups are in the same spa center (Sukenik S, Buskila D, Neumann L) • Balneotherapy with different application modalities in a spa center (Şen U) • Balneotherapy in the spa center, controls in daily living area (Dönmez A, Kesiktaş N)

  11. Groups Effectiveness Yurtkuran M Celiktas M 1996 FM 40 20 women 2 weeks 37oC 20 minutes thermal bath + Relaxation Exercise End of Therapy, 2nd, 6th week Pain ↓ Pressure pain tolerance scores↑ 20 women 2 weeks Relaxation Exercise Pain ↓ ( 2nd, 6th week) Out-patient Yurtkuran M, Celiktas M: A randomized, controlled trial of balneotherapy in the treatment of patients with primary fibromyalgia syndrome. Phys Rehab Kur Med 1996:109-112

  12. Groups Effectiveness Evcik D et al 2002 FMS 42 22 patients: 3 weeks (Total 15 thermal baths) 37oC, 20 min Pain (VAS) ↓ Tender points ↓ FIQ ↓ (up to 6 months) BDI ↓ (only after therapy) Out-patient Evcik D et al:The effects of balneotherapy on fibromyalgia patients. Rheumatol Int. 2002 Jun;22(2):56-9

  13. Groups Effectiveness Altan L et al 2003 FMS 50 25 patients: 3 / week (12 weeks) 37oC, 35 min pool-based exercise in thermomineral water In both group 12. and 24 weeks Pain (VAS) ↓ Tender points ↓ FIQ ↓ Fatigue ↓ BDI ↓ Improved Global Evaluation (patiens’ & phy) Out-patient Altan L et al:Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int. 2003Published online 24.09.03

  14. Spa center Buskila D et al: Balneotherapy for fibromyalgia at Dead Sea. Rheumatol Int 2001:105-108

  15. Spa center Neumann L et al: The effect of balneotherapy at the Dead Sea on the quality of life of patients with fibromyalgia. Clin Rheumatol 2001:15-19

  16. Spa center Şen U et al(2002) Comparison of the efficacy of two different traditional spa regimens in patients with fibromyalgia syndrome. PTT Hastanesi Tıp Dergisi 24:78-81 32 Patients with FMS • Group I:17 Patients : 2 baths / day(8 days) • Group II: 15 Patients : 1 bath+ 1 peloid packing/ day(8 days) Group I Group II Group I / II Pain (Before-8. Days) p<0.0001 p<0.0001 NS Tender point count (Before-8. Days) p<0.0001 p<0.007 p<0.00 Total Algometric scour (Before-8. Days) p<0.001 p<0.001 NS Beck Depression Inventory (Before-8. days) p<0.034 p<0.0001 NS Hamilton Depression Rating Scale (Before-8. Days) p<0.001 p<0.001 NS

  17. Spa center Dönmez A et al: Spa therapy in fibromyalgia: A Randomised controlled clinic study (Unpublished data)

  18. Improvement in all study variables in the spa group in short- and middle-term • Improvements in spa group are superior to the controls • FIQ (until 6th month) • Pain (until 1st month) • Tender point count (until 1st month) • Patient’s global assessment (end-of-treatment evaluation) • Fatigue (end-of-treatment evaluation)

  19. Kesiktaş N et al:The short and long time evaluations of some therapy modalities the patients with fibromyalgiasyndrome.(4.Turkish-German Balneology and ClimatologyCongress 2000) Balneotherapy + Electrotherapy(16): After therapyandup to6. months • Pain (VAS)  • Tender points count • Total algometric score • Beck Depression Inventory (BDI) • Hamilton Depression Rating Scale (HDRS) Electrotherapy(20): After therapyandup to6. months • Pain (VAS) ( Only after therapy) • Hassas nokta (Only after therapy) • Total algometric scoreNS • BDI (Only after therapy) • HDRS(Only after therapy) Hydrotherapy + Electrotherapy(20):After therapyandup to6. months • Pain (VAS)  • Tender points count • Total algometric score • BDI  (Only after therapy) • HDRS (Only after therapy)

  20. MECHANISM ? • Heat • Relaxation of muscle spasm • Gate control theory • Peripheral vasodilatation • Increase of beta endorphin level • Rest • Environment change • Stay with other FM patients

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